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An editorial
published online April 25 in the Annals of Internal Medicine
notes that this population typically does not have easy access to
conventional health care, so it is difficult to screen, diagnose
and treat them.

Many Factors Work Against Adequate Treatment

A combination of factors all work to prevent these patients from
receiving the diagnoses and care they need, Talal notes.

Such factors range from discomfort in conventional health care
settings and lack of HCV-related knowledge to fear of
stigmatization that can result from an HCV diagnosis. That’s
in addition to insurance barriers and physicians’ general
reluctance to treat this population.

According to the editorial, “New approaches for people
with substance use disorders are required at every step in the HCV
care paradigm.”

The reason is that following a decade of fairly steady declines
in this population, there have been recent sharp increases in the
number of new HCV infections, particularly among people below the
age of 35, as a direct result of the opioid epidemic.

“We’re seeing infection hot spots,” Talal
says, noting that this is partly a result of the opioid epidemic,
particularly where needle exchange programs are not available.

Such programs are key, Talal says, citing a report issued in
April by the National Academies that found that people who inject
drugs account for approximately 75 percent of all new HCV
infections.

Improving Screening and Linkage Key Goals

To better reach persons with substance use disorders, the
editorial states, HCV screening and linkage to care must
improve.

Screening can be especially problematic because it typically
requires two steps:

confirmation that the person has been exposed to HCV through an
antibody test

additional blood work to determine if the infection is
active

Currently, the second step must be conducted in a conventional
laboratory, a setting these patients rarely access. Recent
advances, however, are designed to assess whether all treatment
services could be delivered on-site so that treatments are
integrated into the substance use treatment facility.

Telehealth Techniques Used in Clinics and Prisons

Once a diagnosis is made, getting patients connected with
providers is another major hurdle.

“At best, only 20 percent of these patients connect with a
provider for treatment, and often it’s far less than
that,” Talal explains.

Talal and his research partners have been developing promising
ways to better connect these patients with the care they need by
integrating HCV screening and treatment into methadone clinics that
these patients already regularly attend and by reaching patients in
the corrections system via telehealth techniques.

“Since patients already visit the methadone clinic between
one and six times per week, it seems to make sense to have them get
their HCV treatment at the same time,” Talal says. “We
did this in a pilot study at a methadone clinic in Manhattan, and
it has worked very well.”